Hemorrhagic Disorders

Early Pregnancy Bleeding

  • Serious complication immediate attention

Spontaneous Abortion

  • End of pregnancy before 20th weeks GA, natural causes
  • Induced - artificial by meds or mechanical means for therapeutic/personal reason

Threatened - bleeding w/o knowing
Imminent - going to happen
Incomplete - pass product of conceptions
Complete - everything has passes
Missed - there is a sac, but no FHR; body should have aborted, but did not
Recurrent - habitual
Septic

Etiology

  • ~50% result from chromosomal abnormalities

Maternal factors:

  • Infections - herpes, GBS, syphilis
  • Progesterone deficiency
  • Autoimmune - antiphospholid antibody syndrome
  • Drugs and environmental chemicals - smoking, alcohol, mercury

Ectopic Pregnancy

  • any preg that occurs when embryo implants in tissue other than lining of uterus

Management - severity determines the aggressiveness of treatment

Nursing Care

  • Assess amnt and appearance of vaginal bleeding
  • Monitor vitals and discomfort
  • Assess need for RhoGam if mom negative
  • Assess FHR
  • Assess psychosocial needs

Nursing and Collaborative Management

  • Inevitable or incomplete - higher incidence of hemorrhage therefore in hospital

S&S for Hemorrhage

  • Vital sign changes
    • Tachycardia, decreased systolic BP (vasoconstriction), cold, pale skin
  • Amnt and characteristics of bleeding, clot sizes, and tissues

S&S for Shock

  • Vitals changes
    • Low BP, rapid HR, poor end-organ perfusion, weak pulses
  • Dizziness, light-headed
  • Changes in LOC

Nursing Diagnosis

  • Fear, acute pain, grief

Would show lower abdominal pain

  • Tubal - most common
  • Ovarian
  • Cervical
  • Abdominal

Risk Factors- want to get before it ruptures

  • Tubal damage
  • Previous pelvic or tubal surgery
  • Endometriosis
  • IUD
  • Smoking
  • Advanced maternal age
  • Primary infertility

Classic Symptoms

  • Abdominal pain
  • Amenorrhea
  • Vaginal bleeding (maybe)

Fallopian Tube Distention pain is early

  • vague pain or cramping
    • Right or left pelvic areaa

Rupture Symptoms

  • Abdominal pain
  • Palpable pelvic mass
  • Dizziness
  • eventually -> Hypovolemic shock

Diagnosis by:

  • Ultrasound
  • Progesterone evaluation
  • hCG levels
    Normal - sac seen @ 5-6 weeks
    Ectopic - positive preg test, but inability to visualize sac

Treatment
Medical:

  • Methotrexate
  • Surgery

Nursing Care

  • Assess bleeding
  • Vitals
  • Emotional status and coping
  • Education
  • Postop care, RhoGam

Nursing Diagnosis

  • Fear
  • Acute pain
  • Grief
  • Knowledge deficit

Gestational Trophoblastic Disease

Hydatiform Mole - pathologic proliferation of trophoblastic cells